Use these instructions when
completing a Statement of Conversion pursuant to §
7-90-201.7 (3) of the Colorado Revised Statutes (C.R.S.). The
required form/cover sheet must be used when submitting the document for filing.
Mistakes may have legal consequences: review the information provided
carefully. The Colorado Secretary of State’s Office cannot provide legal
advice. Questions should be addressed to your legal, business or tax
advisor(s). Only provide information that is required or permitted to be
included in the document. Information included in the document must be in
English, typewritten or machine printed, and must state the name and address of
at least one individual causing the document to be delivered for filing. In
order to obtain a copy of the filed document or access additional information,
including Frequently Asked Questions (FAQs), visit our Web site, www.sos.state.co.us.

Instructions

Resulting Entity Information: The initial fields relate to the entity as it will
exist after the conversion. These fields
are as follows:

Entity Name: The Entity Name field will be pre-filled with the
result of the Name Availability Search. This information cannot be changed. If
this information is incorrect, click on “Previous Page” to return to the Name
Availability Search page.

Form of Entity: The Form field will be
pre-filled with the form of the entity selected from the Conversion page. This information cannot be changed. If the entity form
is incorrect, return to the Conversion page and select the correct entity form.
To return to the Conversion page, click on “Previous Page” on the Statement of
Conversion page and then click on “Previous Page” on the Resulting Entity Name
Availability Search page.

Jurisdiction of Entity: The Jurisdiction field will be pre-filled with “Colorado”. If Colorado is not the
jurisdiction of formation for the resulting entity, return to the Conversion
page and select a different form from the list that does not result in a
domestic entity. To return to the Conversion page, click on “Previous Page” on
the Statement of Conversion page and then click on “Previous Page” on the
Resulting Entity Name Availability Search page.

Converting Entity Information: The next series of fields relate to the entity as it
exists prior to the conversion. These fields are as follows:

True Name of the Converting Entity: Provide the true name of the converting entity. For
legal authority, refer to §
7-90-601, C.R.S.

Form of Entity: Select the form of the converting entity from the
drop-down list. If “Other” is selected, provide the form of the entity in the
space provided.

Jurisdiction of Entity: Select the jurisdiction of the converting entity from
the drop-down list. If “Other” is selected, provide the jurisdiction of the
entity in the space provided.

Principal Office Address:

Principal Office Street Address: A street
address is required. Provide the street name and number, including the suite,
unit or apartment number, if applicable. The city, state, and ZIP/postal code
must also be provided. Any address outside of the United States must include the
country and, if applicable, the province.

Example:
123 N. Main Street,
Apt 101 Denver, Colorado 80202

Principal Office Mailing Address: A mailing address is optional. If the mailing address
is different than the street address, or mail cannot be delivered to the street
address, provide the address, including the city, state and ZIP/postal code where
mail is to be delivered. Any address outside of the United States must include the
country and, if applicable, the province.

Example:
P.O. Box 854 Lakewood, Colorado 80228

Statement Regarding Conversion: A statement is required that the converting entity
has been converted into the resulting entity pursuant to §
7-90-201.7, C.R.S.

Additional Information: Click the “Yes” button if additional information is
permitted or required by law to be included in the document. After clicking on
“Submit” at the bottom of the online form, the Manage Attachments page will
appear. This will allow additional information to be attached as a plain text
(.txt) or PDF (.pdf) document.